University of Arizona College of Medicine, Phoenix, Arizona.
University of South Florida, Tampa, Florida.
Am J Cardiol. 2020 Sep 1;130:7-14. doi: 10.1016/j.amjcard.2020.05.045. Epub 2020 Jun 7.
Influenza is associated with significant morbidity in the United States but its influence on in-hospital outcomes in patients with AMI has not been well studied. The Nationwide Readmission Database (NRD) from 2010 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥18 years who were admitted for AMI with and without concurrent influenza. Propensity score matching was used to adjust patients' baseline characteristics and co-morbidities. In-hospital mortality, 30-day readmission rates, in-hospital complications, and resource utilization were analyzed. We identified a total of 2,428,361 patients admitted with AMI, of whom 3,006 (0.12%) had coexisting influenza. We noted significantly higher in-hospital mortality (7.7% vs 5.6%, p <0.01) and 30-day readmission rates (15.8% vs 14.1%, p <0.01) in patients with influenza compared with those without it. After propensity matching, the differences in in-hospital mortality and 30-day readmission were no longer statistically significant between the groups. Patients with influenza had a higher incidence of acute kidney injury (30.9% vs 24.6%, p <0.01), acute respiratory failure (50.2% vs 32.2%, p <0.01), need for mechanical ventilation (13.9% vs 9.2%, p <0.01), and sepsis (10% vs 3.8%, p <0.01) in the matched cohort. Patients with influenza had longer hospital stays (8.4 days vs 6.4 days, p <0.01) and mean costs of care (26,200USD vs 23,400USD, p <0.01). In conclusion, AMI patients with concomitant influenza infection had higher in-hospital mortality, 30-day readmission, in-hospital complications, and higher resource utilization compared with those without influenza.
在美国，流感与较高的发病率相关，但流感对急性心肌梗死（AMI）患者住院结局的影响尚未得到很好的研究。使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码，从 2010 年至 2014 年的全国再入院数据库（NRD）中查询了所有年龄≥18 岁的因 AMI 入院的患者，包括伴有和不伴有同时流感的患者。使用倾向评分匹配来调整患者的基线特征和合并症。分析了住院死亡率、30 天再入院率、住院并发症和资源利用情况。我们共确定了 2428361 例因 AMI 入院的患者，其中 3006 例（0.12%）同时患有流感。与不伴有流感的患者相比，伴有流感的患者住院死亡率（7.7% vs 5.6%，p<0.01）和 30 天再入院率（15.8% vs 14.1%，p<0.01）明显更高。经过倾向评分匹配后，两组间住院死亡率和 30 天再入院率的差异不再具有统计学意义。与不伴有流感的患者相比，伴有流感的患者急性肾损伤发生率（30.9% vs 24.6%，p<0.01）、急性呼吸衰竭发生率（50.2% vs 32.2%，p<0.01）、需要机械通气的发生率（13.9% vs 9.2%，p<0.01）和败血症发生率（10% vs 3.8%，p<0.01）更高。伴有流感的患者住院时间更长（8.4 天 vs 6.4 天，p<0.01），住院费用更高（26200 美元 vs 23400 美元，p<0.01）。总之，与不伴有流感感染的 AMI 患者相比，伴有流感感染的 AMI 患者住院死亡率、30 天再入院率、住院并发症和资源利用率更高。
